Circulation, Vol 87, 1489-1497, Copyright © 1993 by American Heart Association
EJ Topol, SG Ellis, DM Cosgrove, ER Bates, DW Muller, NJ Schork, MA Schork and FD Loop
BACKGROUND. Coronary angioplasty is frequently performed in the United
States, with more than 300,000 procedures in 1990. Despite the high rate of
use of the procedure, there have been few studies addressing practice
patterns. METHODS AND RESULTS. From a private insurance claims data base of
5.4 million individuals, a total of 2,101 patients who underwent coronary
angioplasty during 1988-1989 were identified. Using their 4,578 hospital
admission records and 87,578 outpatient claim records, with an average
follow-up of 332 +/- 182 days, we compared patients' outcomes and charges
according to whether they had an exercise stress test before the procedure,
by sex, by region of the country, and by whether the angioplasty was
performed in an institution with a training program. Only 29% of the study
cohort had exercise testing before angioplasty; patients in the West (p =
0.001), those undergoing multivessel angioplasty (p = 0.00001), and those
whose procedures were performed at sites with training programs (p = 0.04)
were more likely to have a screening test, whereas women (p = 0.008) and
those with a recent myocardial infarction (p = 0.00001) were less likely to
have a screening test. The average length of stay for patients without
myocardial infarction as a primary diagnosis was 5.6 days, with a total
hospital charge of $15,027. In follow-up, 15.1% had coronary artery bypass
surgery and 15% had at least one additional angioplasty procedure; the
average follow-up charges were $4,879. Charges varied according to sex,
region of the country, and academic status of the angioplasty institution.
Certain outcomes showed variation by region of the country and academic
status of the angioplasty institution. CONCLUSIONS. The relative lack of an
objective definition of myocardial ischemia and the marked variability of
use of procedures according to geographic region suggest the need for
further implementation of established guidelines.
ARTICLES
Analysis of coronary angioplasty practice in the United States with an insurance-claims data base
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
This article has been cited by other articles:
 |
|
 |
|
  H.-S. Lim, M.-H. Yoon, S.-J. Tahk, H.-M. Yang, B.-J. Choi, S.-Y. Choi, S.-S. Sheen, G.-S. Hwang, S.-J. Kang, and J.-H. Shin Usefulness of the index of microcirculatory resistance for invasively assessing myocardial viability immediately after primary angioplasty for anterior myocardial infarction Eur. Heart J., December 1, 2009; 30(23): 2854 - 2860. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Sarno, I. Decraemer, P. K. Vanhoenacker, B. De Bruyne, M. Hamilos, T. Cuisset, E. Wyffels, J. Bartunek, G. R. Heyndrickx, and W. Wijns On the Inappropriateness of Noninvasive Multidetector Computed Tomography Coronary Angiography to Trigger Coronary Revascularization: A Comparison With Invasive Angiography J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 550 - 557. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A. Lin, R. A. Dudley, F. L. Lucas, D. J. Malenka, E. Vittinghoff, and R. F. Redberg Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention JAMA, October 15, 2008; 300(15): 1765 - 1773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Diamond and S. Kaul The Disconnect Between Practice Guidelines and Clinical Practice--Stressed Out JAMA, October 15, 2008; 300(15): 1817 - 1819. [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Brown, T. M. Sundt III, and B. J. Gersh Indications for Revascularization Card. Surg. Adult, January 1, 2008; 3(2008): 551 - 572. [Full Text]
|
|
|
|
|
|
F. Weidemann, P. Jung, C. Hoyer, J. Broscheit, W. Voelker, G. Ertl, S. Stork, C. E. Angermann, and J. M. Strotmann Assessment of the contractile reserve in patients with intermediate coronary lesions: a strain rate imaging study validated by invasive myocardial fractional flow reserve Eur. Heart J., June 2, 2007; 28(12): 1425 - 1432. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Wijns Anatomic-Functional Imaging by Single-Photon Emission Computed Tomography/Computed Tomography as the Cornerstone of Diagnosis and Treatment for Coronary Patients: A Glimpse Into the (Near) Future? J. Am. Coll. Cardiol., March 13, 2007; 49(10): 1068 - 1070. [Full Text] [PDF]
|
|
|
|
 |
|
 K. L. Gould Physiological severity of coronary artery stenosis Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2583 - H2585. [Full Text] [PDF]
|
|
|
|
|
|
A. Berger, K.-J. Botman, P. A. MacCarthy, W. Wijns, J. Bartunek, G. R. Heyndrickx, N. H.J. Pijls, and B. De Bruyne Long-Term Clinical Outcome After Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease J. Am. Coll. Cardiol., August 2, 2005; 46(3): 438 - 442. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Lindstaedt, M. K. Fritz, A. Yazar, C. Perrey, A. Germing, P. H. Grewe, A. M. Laczkovics, A. Mugge, and W. Bojara Optimizing revascularization strategies in patients with multivessel coronary disease: Impact of intracoronary pressure measurements J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 897 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. H.J. Pijls The interventionalist's dilemma: innocent intimal hyperplasia or in-stent restenosis? Eur. Heart J., November 2, 2004; 25(22): 1970 - 1971. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Voudris, D. Avramides, M. Koutelou, J. Malakos, A. Manginas, M. Papadakis, and D. V. Cokkinos Relative Coronary Flow Velocity Reserve Improves Correlation With Stress Myocardial Perfusion Imaging in Assessment of Coronary Artery Stenoses Chest, October 1, 2003; 124(4): 1266 - 1274. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. F. Fearon, L. B. Balsam, H. M. O. Farouque, R. C. Robbins, P. J. Fitzgerald, P. G. Yock, and A. C. Yeung Novel Index for Invasively Assessing the Coronary Microcirculation Circulation, July 1, 2003; 107(25): 3129 - 3132. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Sundt III, B. J. Gersh, and H. C. Smith Indications for Coronary Revascularization Card. Surg. Adult, January 1, 2003; 2(2003): 541 - 559. [Full Text]
|
|
|
|
|
|
H. Samady, M. Ragosta, and G. A. Beller Coronary collaterals, stenoses, and stents: Is a new era of physiologic-guided percutaneous revascularization emerging? J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1551 - 1554. [Full Text] [PDF]
|
|
|
|
|
|
C. Indolfi, D. Torella, C. Coppola, E. Stabile, G. Esposito, A. Curcio, A. Pisani, L. Cavuto, O. Arcucci, M. Cireddu, et al. Rat carotid artery dilation by PTCA balloon catheter induces neointima formation in presence of IEL rupture Am J Physiol Heart Circ Physiol, August 1, 2002; 283(2): H760 - H767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Sicari, P. Landi, E. Picano, S. Pirelli, G. Chiaranda, M. Previtali, G. Seveso, N. Gandolfo, F. Margaria, O. Magaia, et al. Exercise-electrocardiography and/or pharmacological stress echocardiography for non-invasive risk stratification early after uncomplicated myocardial infarction. A prospective international large scale multicentre study Eur. Heart J., July 1, 2002; 23(13): 1030 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Munoz, J. R. Blanco, M. Rodriguez-Creixems, E. Garcia, J. L. Delcan, and E. Bouza Bloodstream Infections After Invasive Nonsurgical Cardiologic Procedures Arch Intern Med, September 24, 2001; 161(17): 2110 - 2115. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. W. Bech, B. De Bruyne, N. H.J. Pijls, E. D. de Muinck, J. C.A. Hoorntje, J. Escaned, P. R. Stella, E. Boersma, J. Bartunek, J. J. Koolen, et al. Fractional Flow Reserve to Determine the Appropriateness of Angioplasty in Moderate Coronary Stenosis : A Randomized Trial Circulation, June 19, 2001; 103(24): 2928 - 2934. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Wieneke, M. Haude, J. Ge, C. Altmann, S. Kaiser, D. Baumgart, C. von Birgelen, D. Welge, and R. Erbel Corrected coronary flow velocity reserve: a new concept for assessing coronary perfusion J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1713 - 1720. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Califf, K. S. Pieper, K. L. Lee, F. Van de Werf, R. J. Simes, P. W. Armstrong, and E. J. Topol Prediction of 1-Year Survival After Thrombolysis for Acute Myocardial Infarction in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries Trial Circulation, May 16, 2000; 101(19): 2231 - 2238. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Hueb, P. R. Soares, S. Almeida de Oliveira, S. Arie, R. H. A. Cardoso, D. B. Wajsbrot, L. A. M. Cesar, A. D. Jatene, and J. A. F. Ramires Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS) : A Prospective, Randomized Trial of Medical Therapy, Balloon Angioplasty, or Bypass Surgery for Single Proximal Left Anterior Descending Coronary Artery Stenosis Circulation, November 9, 1999; 100 (2009): II-107 - II-113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H J Verberne, J J Piek, R A M van Liebergen, K T Koch, J M Schroeder-Tanka, and E A van Royen Functional assessment of coronary artery stenosis by Doppler derived absolute and relative coronary blood flow velocity reserve in comparison with 99mTc MIBI SPECT Heart, October 1, 1999; 82(4): 509 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Abizaid, G. S. Mintz, R. Mehran, A. Abizaid, A. J. Lansky, A. D. Pichard, L. F. Satler, H. Wu, C. Pappas, K. M. Kent, et al. Long-Term Follow-Up After Percutaneous Transluminal Coronary Angioplasty Was Not Performed Based on Intravascular Ultrasound Findings : Importance of Lumen Dimensions Circulation, July 20, 1999; 100(3): 256 - 261. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, R. Hachamovitch, D. S. Berman, T. H. Marwick, M. S. Lauer, G. V. Heller, A. E. Iskandrian, K. L. Kesler, M. I. Travin, H. C. Lewin, et al. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia J. Am. Coll. Cardiol., March 1, 1999; 33(3): 661 - 669. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Cortigiani, E. Picano, P. Landi, M. Previtali, S. Pirelli, P. Bellotti, R. Bigi, O. Magaia, A. Galati, E. Nannini, et al. Value of pharmacologic stress echocardiography in risk stratification of patients with single-vessel disease: a report from the echo-persantine and echo-dobutamine international cooperative studies J. Am. Coll. Cardiol., July 1, 1998; 32(1): 69 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Topol, J. J. Ferguson, H. F. Weisman, J. E. Tcheng, S. G. Ellis, N. S. Kleiman, R. J. Ivanhoe, A. L. Wang, D. P. Miller, K. M. Anderson, et al. Long-term Protection From Myocardial Ischemic Events in a Randomized Trial of Brief Integrin {beta}3 Blockade With Percutaneous Coronary Intervention JAMA, August 13, 1997; 278(6): 479 - 484. [Abstract] [PDF]
|
|
|
|
|
|
L. I. Heller, C. Cates, J. Popma, L. I. Deckelbaum, J. D. Joye, S. T. Dahlberg, B. J. Villegas, A. Arnold, R. Kipperman, W. C. Grinstead, et al. Intracoronary Doppler Assessment of Moderate Coronary Artery Disease : Comparison With 201Tl Imaging and Coronary Angiography Circulation, July 15, 1997; 96(2): 484 - 490. [Abstract] [Full Text]
|
|
|
|
|
|
G. Sambuceti, M. Marzilli, P. Marraccini, J. Schneider-Eicke, E. Gliozheni, O. Parodi, and A. L'Abbate Coronary Vasoconstriction During Myocardial Ischemia Induced by Rises in Metabolic Demand in Patients With Coronary Artery Disease Circulation, June 17, 1997; 95(12): 2652 - 2659. [Abstract] [Full Text]
|
|
|
|
|
|
D. Hasdai, P. B. Berger, M. R. Bell, C. S. Rihal, K. N. Garratt, and D. R. Holmes Jr The Changing Face of Coronary Interventional Practice: The Mayo Clinic Experience Arch Intern Med, March 24, 1997; 157(6): 677 - 682. [Abstract] [PDF]
|
|
|
|
|
|
E. M. Ohman and B. E. Tardiff Periprocedural Cardiac Marker Elevation After Percutaneous Coronary Artery Revascularization: Importance and Implications JAMA, February 12, 1997; 277(6): 495 - 497. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Paulin, N. H.J. Pijls, B. De Bruyne, and R. F. Wilson Functional Severity of Coronary-Artery Stenoses N. Engl. J. Med., November 28, 1996; 335(22): 1687 - 1688. [Full Text]
|
|
|
|
|
|
N. H.J. Pijls, B. de Bruyne, K. Peels, P. H. van der Voort, H. J.R.M. Bonnier, J. Bartunek, and J. J. Koolen Measurement of Fractional Flow Reserve to Assess the Functional Severity of Coronary-Artery Stenoses N. Engl. J. Med., June 27, 1996; 334(26): 1703 - 1708. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. O. Cannon III and M. Lesch The Search for a Better Exercise Test : A Self-Fulfilling Prophecy? Circulation, January 15, 1996; 93(2): 205 - 207. [Full Text]
|
|
|
|
|
|
J.-C. Barthelemy, F. Roche, J.-M. Gaspoz, A. Geyssant, P. Minini, A. Antoniadis, E. Page, J.-E. Wolf, C. Wilner, K. Isaaz, et al. Maximal Blood Lactate Level Acts as a Major Discriminant Variable in Exercise Testing for Coronary Artery Disease Detection in Men Circulation, January 15, 1996; 93(2): 246 - 252. [Abstract] [Full Text]
|
|
|
|
|
|
N. H.J. Pijls, B. Van Gelder, P. Van der Voort, K. Peels, F. A.L.E. Bracke, H. J.R.M. Bonnier, and M. I.H. El Gamal Fractional Flow Reserve : A Useful Index to Evaluate the Influence of an Epicardial Coronary Stenosis on Myocardial Blood Flow Circulation, December 1, 1995; 92(11): 3183 - 3193. [Abstract] [Full Text]
|
|
|
|
|
|
E. J. Topol and S. E. Nissen Our Preoccupation With Coronary Luminology : The Dissociation Between Clinical and Angiographic Findings in Ischemic Heart Disease Circulation, October 15, 1995; 92(8): 2333 - 2342. [Abstract] [Full Text]
|
|
|
|
|
|
L. Pilote, R. M. Califf, S. Sapp, D. P. Miller, D. B. Mark, W. D. Weaver, J. M. Gore, P. W. Armstrong, E. M. Ohman, E. J. Topol, et al. Regional Variation across the United States in the Management of Acute Myocardial Infarction N. Engl. J. Med., August 31, 1995; 333(9): 565 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Ellis, D. P. Miller, K. J. Brown, N. Omoigui, G. L. Howell, M. Kutner, and E. J. Topol In-Hospital Cost of Percutaneous Coronary Revascularization : Critical Determinants and Implications Circulation, August 15, 1995; 92(4): 741 - 747. [Abstract] [Full Text]
|
|
|
|
|
|
B. De Bruyne, J. Bartunek, S. U. Sys, and G. R. Heyndrickx Relation Between Myocardial Fractional Flow Reserve Calculated From Coronary Pressure Measurements and Exercise-Induced Myocardial Ischemia Circulation, July 1, 1995; 92(1): 39 - 46. [Abstract] [Full Text]
|
|
|
|
|
|
K. B. Michels and S. Yusuf Does PTCA in Acute Myocardial Infarction Affect Mortality and Reinfarction Rates? : A Quantitative Overview (Meta-Analysis) of the Randomized Clinical Trials Circulation, January 15, 1995; 91(2): 476 - 485. [Abstract] [Full Text]
|
|
|
|
|
|
M. J. Kern, R. G. Bach, M. L. d. A. Kallfelz, R. C. Degrazia, I. Rashdan, D. Tolchin, B. J. Ania, M. A. Cardenes, S. G. Pauker, and R. I. Kopelman Clinical Problem-Solving: Invasive Interventions N. Engl. J. Med., January 12, 1995; 332(2): 125 - 127. [Full Text]
|
|
|
|
|
|
C. Landau, R. A. Lange, and L. D. Hillis Percutaneous Transluminal Coronary Angioplasty N. Engl. J. Med., April 7, 1994; 330(14): 981 - 993. [Full Text]
|
|
|
|
|
|
E. J. Topol, F. Leya, C. A. Pinkerton, P. L. Whitlow, B. Hofling, C. A. Simonton, R. R. Masden, P. W. Serruys, M. B. Leon, D. O. Williams, et al. A Comparison of Directional Atherectomy with Coronary Angioplasty in Patients with Coronary Artery Disease N. Engl. J. Med., July 22, 1993; 329(4): 221 - 227. [Abstract] [Full Text]
|
|